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Difficulty: MediumGastroenterology and Hepatology

A series of patients present to the primary care clinic for routine health screening and evaluation of liver function. As part of their workup, Hepatitis B serologic testing is performed. Match the following Hepatitis B serologic profiles with their most accurate clinical interpretation.

  • HBsAg (+), Anti-HBc IgM (+), HBeAg (+), Anti-HBs (-)Acute Hepatitis B infection
  • HBsAg (-), Anti-HBc Total/IgG (+), Anti-HBs (+)Resolved natural Hepatitis B infection
  • HBsAg (+), Anti-HBc Total/IgG (+), HBeAg (-), Anti-HBs (-)Chronic Hepatitis B infection
  • HBsAg (-), Anti-HBc Total/IgG (-), Anti-HBs (+)Immunity secondary to Hepatitis B vaccination

Answer

The correct matches are: 1) Acute Hepatitis B infection is characterized by positive HBsAg and positive Anti-HBc IgM. 2) Resolved natural Hepatitis B infection shows positive Anti-HBc IgG and positive Anti-HBs. 3) Chronic Hepatitis B infection presents with positive HBsAg and positive Anti-HBc IgG, without Anti-HBs. 4) Immunity secondary to Hepatitis B vaccination demonstrates positive Anti-HBs only, without any core antibodies.
Matching correctly relies on systematically evaluating HBsAg (active disease marker), Anti-HBc (differentiates acute from chronic/resolved, and natural infection from vaccine immunity), and Anti-HBs (protective immunity marker).

Step-by-Step Solution

1
Analyze the status of the Hepatitis B surface antigen (HBsAg).
Positive HBsAg indicates active infection (acute or chronic), while negative HBsAg indicates no active infection.
HBsAg is the first serologic marker to appear in active infection and must clear for resolution.
2
Evaluate the Hepatitis B core antibody (Anti-HBc) type.
Anti-HBc IgM indicates acute infection, whereas Anti-HBc IgG indicates past or chronic infection. Absence of Anti-HBc in an immune patient indicates vaccination.
Core antibodies are formed only against the actual virus, never against the vaccine.
3
Check for the presence of the Hepatitis B surface antibody (Anti-HBs).
Positive Anti-HBs signifies immunity, either from natural resolution or from vaccination.
Anti-HBs is a neutralizing antibody that provides protective, long-term immunity.

Key Concept

Interpretation of Hepatitis B Serologic Panels
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Topics

Gastroenterology and Hepatology

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